UTILIZATION MANAGEMENT:

Intake, Clinical Review and Call Center

National Health Plan partnership to develop an international care management center of excellence. Agile and scalable model combining EXL’s cutting edge Analytics and Clinical Capabilities to drive business outcomes

  • Improved process efficiencies (such as reduced AHT) through automation, reduced penalty risks
  • Improvement in member engagement
  • Scientific process management leading to improved decision making

CLINICAL CLAIM AND BILL REVIEW:

National HP partnership

Combination of payment expertise and process automation with bench of experts to perform clinical claim review.

MEMBER OUTREACH:

Leveraging digitally enabled clinical services to improve member outreach and engagement in lifestyle, disease and care management programs.

PBM: PRE- PAYMENT COST AVOIDANCE:

A top national PBM needed an efficient process to review pharmacy claims for discrepancies/errors prior to payment. Ability to leverage auditor expertise and IT resources to have a scalable and repeatable program across all lines of business to avoid inappropriate payments.


Written by EXL Healthcare Team

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